Monday, March 20, 2006

An unbelievable story from the San Diego Union-Tribune today. Troops are now returning to the field of battle carrying their own supply of antidepressant and anti-anxiety medicine; service members who are having mental health issues are routinely sent into combat for a second, third, or fourth tour. Is this safe? Is this sane policy?

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From the article:

The redeployments are legal, and the service members are often eager to go. But veterans groups, lawmakers and mental-health professionals fear that the practice lacks adequate civilian oversight. They also worry that such redeployments are becoming more frequent as multiple combat tours become the norm and traumatized service members are retained out of loyalty or wartime pressures to maintain troop numbers.

Sen. Barbara Boxer hopes to address the controversy through the Department of Defense Task Force on Mental Health, which is expected to start work next month. The California Democrat wrote the legislation that created the panel. She wants the task force to examine deployment policies and the quality and availability of mental-health care for the military.

“We've also heard reports that doctors are being encouraged not to identify mental-health illness in our troops. I am asking for a lot of answers,” Boxer said during a March 8 telephone interview. “If people are suffering from mental-health problems, they should not be sent on the battlefield.”

“I have not seen anything that says this is a good thing to use these drugs in high-stress situations. But if you are going to be going (into combat) anyway, you are better off on the meds,” said Ochberg, a former consultant to the Secret Service and the National Security Council. “I would hope that those with major depression would not be sent.”

The DOD doesn't keep track of troops returning to combat medicated for mental health disorders; however, Army and Marine Corps medical officers confirm that medicated soldiers and marines are returning to the combat zone.

Buttressing the idea that large numbers of service members are medicated, more than 200,000 prescriptions for the most common types of antidepressants were written in the past 14 months for service members and their families, said Sydney Hickey, a spokeswoman for the National Military Family Association.

Hicks said a Defense Department official gave her the information during a December briefing. She said the official did not distinguish between prescriptions for the troops and those for their family members. In addition, the Defense Department has not provided prescription totals for such antidepressants from before and after the United States invaded Iraq in 2003.

Politics and penny-pinching are part of the problem.

Mental-health care for service members and the Defense Department's efforts to keep the mentally ill in uniform are becoming national issues, said Steve Robinson, director of the National Gulf War Resource Center in Silver Spring, Md. Robinson said three Army doctors have told him about being pressured by their commanders not to identify mental conditions that would prevent personnel from being deployed.

“They are being told to diagnose combat-stress reaction instead of PTSD,” he said. “That does two things: It keeps the troops deployable and it makes it hard for them to collect disability claims once they get out of the military.” Robinson contends that the Pentagon is trying to control its spending on mental-health disabilities. ...

Overall, service members' mental health is a hot-button subject because it goes to the cost of the war in dollars and lives, said Joy Ilem, an assistant national legislative director for the organization Disabled American Veterans. “The (Department of Veterans Affairs) is very worried about the political implications of PTSD and other mental issues arising from the war,” Ilem said. “They are talking about early outreach and treatment, but they are really trying to tamp down the discussion.”

Medical practice and ethics questions loom large, too.

Cmdr. Paul S. Hammer deals with such issues daily. Hammer, a psychiatrist, is responsible for the Marine Corps' mental-health programs during this deployment rotation. He confirmed that Marines with post-traumatic stress disorder and combat stress are returning to Iraq, though he would not say how many.

Hammer said deciding who is deployed is often anguishing. Sometimes he has to tell Marine commanders that personnel they had counted on will not be deploying. In other instances, he said, “We'll hold some guy's feet to the fire and say, 'This is what you signed up for, and you have to go.'” Marines are “amazingly resilient,” Hammer added. “You've got people exposed to incredible violence, but they do entirely well.”

It's the tough calls that worry Adrian Atizado, a legislative director for Disabled American Veterans. “Currently, the services will deploy a service member if the person is medically stable and it is determined that the deployment won't aggravate (his) condition,” Atizado said. “How does one gauge that? This a gray area; this is asking a medical provider to make a decision based on the future. The medical providers are human beings. I have no doubt that they are looking out for the best interest of the service members, but they are under pressure to check off on their deployment.”

Ultimately, much is unknown about the rates of post-traumatic stress disorder among Iraq veterans, especially those who have been through more than one combat tour, said Matt Friedman, executive director of the U.S. Department of Veterans Affairs National Center for PTSD in White River Junction, Vt.

Friedman said that with time, “one of the things we are going to find out is how well people function who might have been on medication (during combat). This is a very important question and has all kinds of implications. “But remember, they are all volunteers. This isn't Vietnam, where people were drafted and sent to fight. Think of the ethical questions that would arise from sending draftees back to war on medications.”

While a wide variety of events can trigger what's called post-traumatic stress disorder, this PTSD blog focuses solely on the combat-related variety.
As a new generation of warriors returns to civilian life and seeks out resources, PTSD Combat is here to help.

Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell

"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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